An Anatomic Study of the Sural Nerve Using 3-Tesla MRI: A Comparison to Cadaveric Data With Surgical Applications

2021 ◽  
pp. 107110072110517
Author(s):  
Claudio B. Ghetti ◽  
Brendon C. Mitchell ◽  
Vrajesh J. Shah ◽  
Wilbur Wang ◽  
Brady Huang ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Sural Nerve ◽  
Lateral Approach ◽  
Magnetic Resonance Images ◽  
Small Sample ◽  
Iatrogenic Injury ◽  
Lateral Malleolus ◽  
3 Tesla ◽  
Horizontal Distance ◽  
3 Tesla Mri

Background: The sural nerve (SN) is a sensory cutaneous nerve that is at risk of iatrogenic injury during surgery at the lateral ankle. Prior anatomic studies of the SN are limited primarily to cadaveric studies with small sample sizes. Our study analyzed a large cohort of magnetic resonance images (MRIs) of the ankle to obtain a more generalizable, in vivo sample of distal SN course. Methods: A total of 204 3-tesla MRI studies of the ankle were analyzed. Three reviewers measured the distance from the SN to various landmarks including the distal tip of the lateral malleolus (DTLM) and the lateral border of the Achilles tendon (LBA). Results: Mean vertical distance from SN to DTLM was 2.2 cm (range, 0.9-3.6 cm). Mean horizontal distance from SN to DTLM and to LBA at the level of DTLM was 1.7 cm (range, 0.8-3.0 cm) and 1.9 cm (range, 1.0-2.9 cm), respectively. Mean horizontal distance from SN to LBA at the level of superior Achilles tendon insertion onto the calcaneus (SAI) was 2.6 cm (range, 1.4-3.7 cm), and mean horizontal distance from SN to LBA at 5 cm above SAI was 0.9 cm (range, 0.4-1.8 cm). Conclusion: The variation in SN course observed in our study allowed us to propose “safe zones” for several surgical approaches including the extensile lateral approach to the calcaneus (ELAC), the sinus tarsi approach (STA), the direct lateral approach to the lateral malleolus (DLA), and the posterolateral approach to the ankle (PLA), which we hope will minimize iatrogenic injury to the SN. Level of Evidence: Level IV, case series.

Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures

2018 ◽  
Vol 39 (9) ◽  
pp. 1106-1112 ◽  
Author(s):  
Shaoliang Li
Keyword(s):  
Nerve Injury ◽  
Sural Nerve ◽  
Iatrogenic Injury ◽  
Lateral Malleolus ◽  
Wound Complications ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Group A ◽  
Group B ◽  
Calcaneus Fractures

Background The purpose of this study was to evaluate the optimal timing and measures of the sinus tarsi approach for calcaneus fractures to avoid iatrogenic injury of the sural nerve and to assess for wound complications. Methods: A case series of 53 patients with calcaneus fractures treated by a single surgeon with the sinus tarsi approach was retrospectively analyzed. On the basis of the delay time from injury to surgery, patients were classified into 4 groups: immediate (0–3 days), early (4–6 days), intermediate (7–14 days), and late (14–18 days). All patients were followed for at least 1 year to observe wound conditions. The rate of wound complications and iatrogenic sural nerve injury was described. Incisions were classified into 2 groups: group A included patients with incisions extending posterior to the lateral malleolus, and group B included patients with incisions confined anterior to the lateral malleolus. The rates of nerve injury were compared between both groups. Forty-three patients with 52 Sanders type II fractures were included. Results: The average time to surgery from injury was 8.8 days (range, 0–18 days). The overall postoperative rate of wound complications was 5.8% (3 of 52). In the immediate group, deep infections and wound necrosis were found in 2 of 8 fractures (25%). In the early group, 1 of 15 fractures developed superficial infection (6.7%). In the intermediate and late groups, no wound complication was identified. Iatrogenic sural nerve injury was recorded in 5 of 52 patients (9.6%). Group A had 33% (4 of 12) nerve injuries and group B had 2.5% (1 of 40) ( P = .009). In 70% of cases, a main branch of the sural nerve was directly under the incision. Conclusions: The sinus tarsi approach was generally effective and safe for calcaneus fractures. However, it was relatively risky to perform open reduction and internal fixation by the sinus tarsi approach within 6 days of injury. Because the sural nerve is in the vicinity of the approach, iatrogenic injury should be avoided by the use of careful planning and meticulous manipulations. Level of Evidence Therapeutic; Level III, comparative study.

scholarly journals Anatomic Study of Exposed Posterior Malleolus Using the Posterolateral Ankle Approach

2021 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Xin Ma
Keyword(s):  
Achilles Tendon ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Lateral Malleolus ◽  
Bone Block ◽  
Posterior Portion ◽  
Posterior Malleolus ◽  
Starting Point ◽  
Significant Difference ◽  
Exposed Bone

We compared the effect of the posterolateral ankle approach on the exposed posterior malleolus and vascular nerves in order to reduce the probability of vascular nerve injury during surgical exposure. Five corpses were randomly allocated to incision A and B groups. The tip of the lateral malleolus was used as a starting point, while the lateral line of the Achilles tendon was used as the endpoint to its trisection. Using the two points near the side of the Achilles tendon, we drew two vertical horizontal lines to represent incisions A and B, then measured the horizontal distances between the tip of the lateral malleolus and incision A (a), the tip of the lateral malleolus and incision B (b), and the tip of the lateral malleolus and the midpoint of the sural nerve and small saphenous vein (c). We then exposed the fibula from the posterior portion of the peroneus brevis muscles, dissected the flexor pollicis longus from the posterior edge of the fibula, and used Vernier calipers to measure the maximum length and width of the exposed bone block. There was no statistically significant difference between distances (a) and (c), but there was a significant difference between distances (b) and (c). The length of the exposed posterior malleolus did not differ significantly between incisions A and B, but the width differed significantly. Exposing the posterior malleolus using an approach closer to the lateral Achilles tendon is less likely to injure the sural nerve and small saphenous vein and results in a larger exposed area and easier manipulation. Thus, this could be a better surgical treatment for ankle fractures.

The Sural Nerve in the Foot and Ankle: An Anatomic Study with Clinical and Surgical Implications

1994 ◽  
Vol 15 (9) ◽  
pp. 490-494 ◽  
Author(s):  
Steven J. Lawrence ◽  
Michael J. Botte
Keyword(s):  
Achilles Tendon ◽  
Sural Nerve ◽  
Nerve Trunk ◽  
Lateral Malleolus ◽  
Foot And Ankle ◽  
Anatomic Study ◽  
Traumatic Injuries ◽  
Peroneus Longus ◽  
Close Proximity ◽  
Branching Patterns

Operative procedures and traumatic injuries of the lateral foot and ankle place the sural nerve and its branches at risk. Anatomic studies quantifying the course of this nerve are sparse. In this study, 17 cadaver specimens were dissected to clarify its course and branching patterns. Despite multiple variations of the nerve and its branches, description of the course of a “typical” nerve trunk was possible. The nerve was found to lie in close proximity to the Achilles tendon at a level of 7 cm above the tip of the lateral malleolus. In the hindfoot, the nerve coursed 14 mm posterior and 14 mm inferior to the malleolus. Distally, it crossed superficial to the peroneus longus and brevis tendons. An anastomotic branch coursing into the sinus tarsi area was observed in 24% of specimens. An understanding of the course and distribution of the sural nerve may lessen the risk of iatrogenic injury.

Single Cell Imaging of Human Cologenic Carcinoma Cells by 3-Tesla MRI

2004 ◽  
Vol 176 (03) ◽  
Author(s):  
UKM Teichgräber ◽  
JG Pinkernelle ◽  
F Neumann ◽  
T Benter ◽  
H Bruhn ◽  
...  
Keyword(s):  
Single Cell ◽  
Cell Imaging ◽  
Carcinoma Cells ◽  
3 Tesla ◽  
Single Cell Imaging ◽  
3 Tesla Mri

T1 Relaxation Time of Achilles Tendon at 3 Tesla with Special Reference to Relevant Clinical Score: A Preliminary Study

2020 ◽  
Vol 16 (2) ◽  
pp. 164-173
Author(s):  
Zeineb Tbini ◽  
Mokhtar Mars ◽  
Mouna Bouaziz
Keyword(s):  
Relaxation Time ◽  
Achilles Tendon ◽  
Clinical Score ◽  
3 Tesla ◽  
Acquisition Time ◽  
Short Term ◽  
T1 Relaxation Time ◽  
T1 Relaxation ◽  
Spin Echo Sequence ◽  
Significant Difference

Purpose: The purpose of this study was to investigate T1 relaxation time of the human Achilles tendon, to test its short-term repeatability as well as the minimal detectable change, and to assess the extent that correlate with clinical symptoms. Methods: Twenty asymptomatic volunteers and eighteen patients with clinically and sonographically confirmed tendinopathy were scanned for ankle using a 3 Tesla (T) MR scanner. T1 maps were calculated from a variable flip angle gradient echo Ultra-short echo time sequence (VFA-GE UTE) and inversion recovery spin echo sequence (IR-SE) using a self-developed matlab algorithm in three regions of interest of Achilles Tendon (AT). Signal to Noise Ratio (SNR) between the two sequences was evaluated. INTRA-class Correlation Coefficient (ICC), Coefficient of Variation (CV) and the Least Significant Change (LSC) were calculated, to test short-term repeatability of T1. Subjects were assessed by the VISA-A clinical score. P values less than 0.005 were considered statistically significant. Results: Mean T1 values were 427.09 ± 53.37 ms and 528.70 ± 103.50 ms using IR-SE sequence and 575.43 ± 110.60 ms and 875.81 ± 425.77 ms with VFA-GE UTE sequence in the whole AT for volunteers and patients, respectively. : T1 values showed a significant difference between volunteers and patients (P=0.001). Regional variation of T1 in healthy and tendinopathic AT were greater for VFA-GE UTE sequence than for IR-SE sequence. VFA-GE UTE sequence showed clearly higher SNR compared to IR-SE sequence. Short-term repeatability of T1 values for volunteers showed an LSC of 22% and 14% for IR-SE sequence and VFA-GE UTE sequence, respectively. For patients, LSC was 14% and 5% for IR-SE sequence and VFA-GE UTE sequence, respectively. There was no correlation between T1 and VISA-A clinical score (p>0.005). Conclusion: VFA-GE UTE sequence used for T1 mapping calculation demonstrated short acquisition time and clearly high SNR. Results revealed that T1 relaxation time can be used as a biomarker to differentiate between healthy and pathologic Achilles tendon. However, T1 showed no correlation with the VISA-A clinical score.

scholarly journals Potential predictive value of axial T2 mapping at 3 Tesla MRI in patients with untreated patellar cartilage defects over a mean follow-up of four years

2020 ◽  
Vol 28 (2) ◽  
pp. 215-222 ◽  
Author(s):  
S.R. Apprich ◽  
M.M. Schreiner ◽  
P. Szomolanyi ◽  
G.H. Welsch ◽  
U.K. Koller ◽  
...  
Keyword(s):  
Predictive Value ◽  
T2 Mapping ◽  
3 Tesla ◽  
Cartilage Defects ◽  
Patellar Cartilage ◽  
3 Tesla Mri

scholarly journals Interobserver agreement of Prostate Imaging–Reporting and Data System (PI-RADS–v2)

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Hala Maher Ahmed ◽  
Ahmed Ebrahim Ebeed ◽  
Ahmed Hamdy ◽  
Mohamed Abou El-Ghar ◽  
Ahmed Abdel Khalek Abdel Razek
Keyword(s):  
Interobserver Agreement ◽  
Imaging Modality ◽  
Peripheral Zone ◽  
Transitional Zone ◽  
Data System ◽  
3 Tesla ◽  
Prostate Imaging ◽  
Percent Agreement ◽  
3 Tesla Mri

Abstract Background A retrospective study was conducted on 71 consecutive patients with suspected prostate cancer (PCa) with a mean age of 56 years and underwent mp-MRI of the prostate at 3 Tesla MRI. Two readers recognized all prostatic lesions, and each lesion had a score according to Prostate Imaging–Reporting and Data System version 2 (PI-RADS-v2). Purpose of the study To evaluate the interobserver agreement of PI-RADS-v2 in characterization of prostatic lesions using multiparametric MRI (mp-MRI) at 3 Tesla MRI. Results The overall interobserver agreement of PI-RADS-v2 for both zones was excellent (k = 0.81, percent agreement = 94.9%). In the peripheral zone (PZ) lesions are the interobserver agreement for PI-RADS II (k = 0.78, percent agreement = 83.9%), PI-RADS III (k = 0.66, percent agreement = 91.3 %), PI-RADS IV (k = 0.69, percent agreement = 93.5%), and PI-RADS V (k = 0.91, percent agreement = 95.7 %). In the transitional zone (TZ) lesions are the interobserver agreement for PI-RADS I (k = 0.98, percent of agreement = 96%), PI-RADS II (k = 0.65, percent agreement = 96%), PI-RADS III (k = 0.65, percent agreement = 88%), PI-RADS IV (k = 0.83, percent agreement = 96%), and PI-RADS V (k = 0.82, percent agreement = 92%). Conclusion We concluded that PI-RADS-v2 is a reliable and a reproducible imaging modality for the characterization of prostatic lesions and detection of PCa.

The Femoral Footprint Position of the Anterior Cruciate Ligament Might Be a Predisposing Factor to a Noncontact Anterior Cruciate Ligament Rupture

2019 ◽  
Vol 47 (14) ◽  
pp. 3365-3372 ◽  
Author(s):  
Dimitris Dimitriou ◽  
Zhongzheng Wang ◽  
Diyang Zou ◽  
Tsung-Yuan Tsai ◽  
Naeder Helmy
Keyword(s):  
Anterior Cruciate Ligament ◽  
Matched Control ◽  
Cruciate Ligament ◽  
Magnetic Resonance Images ◽  
Small Sample ◽  
Transverse Plane ◽  
Acl Rupture ◽  
Coronal Plane ◽  
Predisposing Factor ◽  
Anterior Cruciate

Background: Although the femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, the recommendations for the ideal femoral footprint position are mostly based on cadaveric studies with small sample sizes, elderly patients with unknown ACL status, and 2-dimensional techniques. Furthermore, a potential difference in the femoral ACL footprint position and ACL orientation between ACL-ruptured and ACL-intact knees has not been reported in the literature. Hypothesis: The femoral ACL footprint position and ACL orientation vary significantly between ACL-ruptured and matched control ACL-intact knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance images of the knees of 90 patients with an ACL rupture and 90 matched control participants who had a noncontact knee injury without an ACL rupture were used to create 3-dimensional models of the femur and tibia. The ACL footprints were outlined on each model, and their positions (normalized to the lateral condyle width) as well as ACL orientations were measured with an anatomic coordinate system. Results: The femoral ACL footprint in patients with an ACL rupture was located at 36.6% posterior and 11.2% distal to the flexion-extension axis (FEA). The ACL orientation was 46.9° in the sagittal plane, 70.3° in the coronal plane, and 20.8° in the transverse plane. The ACL-ruptured group demonstrated a femoral ACL footprint position that was 11.0% more posterior and 7.7% more proximal than that of the control group (all P < .01). The same patients also exhibited 5.7° lower sagittal elevation, 3.1° higher coronal plane elevation, and 7.9° lower transverse plane deviation (all P < .01). The optimal cutoff value of the femoral ACL footprint position to prevent an ACL rupture was at 30% posterior and 12% distal to the FEA. Conclusion: The ACL femoral footprint position might be a predisposing factor to an ACL rupture. Patients with a >30% posterior and <12% distal position of the femoral ACL footprint from the FEA might have a 51.2-times increased risk of an ACL rupture.

Blood oxygen-level dependent functional assessment of cerebrovascular reactivity: Feasibility for intraoperative 3 Tesla MRI

2016 ◽  
Vol 77 (2) ◽  
pp. 806-813 ◽  
Author(s):  
Jorn Fierstra ◽  
Jan-Karl Burkhardt ◽  
Christiaan Hendrik Bas van Niftrik ◽  
Marco Piccirelli ◽  
Athina Pangalu ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Blood Oxygen Level Dependent ◽  
Cerebrovascular Reactivity ◽  
3 Tesla ◽  
Blood Oxygen ◽  
Oxygen Level ◽  
Blood Oxygen Level ◽  
3 Tesla Mri
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